Macular edema following retinal vein occlusion (RVO)

Diabetic macular edema (DME)

IMPORTANT SAFETY INFORMATION

LUCENTIS is contraindicated in patients with ocular or periocular infections or hypersensitivity to ranibizumab or any of the excipients in LUCENTIS.

Intravitreal injections, including those with LUCENTIS, have been associated with endophthalmitis, retinal detachment, and iatrogenic traumatic cataract.

Increases in intraocular pressure have been noted both pre-injection and post-injection with LUCENTIS.

Although there was a low rate of arterial thromboembolic events (ATEs) observed in the LUCENTIS clinical trials, there is a potential risk of ATEs following intravitreal use of VEGF inhibitors. ATEs are defined as nonfatal stroke, nonfatal myocardial infarction, or vascular death (including deaths of unknown cause).

Fatal events occurred more frequently in patients with DME and DR at baseline treated monthly with LUCENTIS compared with control. Although the rate of fatal events was low and included causes of death typical of patients with advanced diabetic complications, a potential relationship between these events and intravitreal use of VEGF inhibitors cannot be excluded.

In the LUCENTIS Phase III clinical trials, the most common ocular side effects included conjunctival hemorrhage, eye pain, vitreous floaters, and increased intraocular pressure. The most common non-ocular side effects included nasopharyngitis, headache, influenza, sinusitis, cough, and nausea.

Consolidated Terms and Conditions

By using the Lucentis Co-pay Card program, the patient acknowledges and confirms that at the time of usage,(s)he is currently eligible and meet the criteria set forth in the terms and conditions described.

Patients are not eligible if you have government insurance such as Medigap, Medicare, Medicaid, Veterans Affairs (VA), Department of Defense (DoD), and TRICARE. Patients who become Government beneficiaries during their enrolment period will no longer be eligible for the program as of the date they become a Government beneficiary.

This Co-Pay Card program is not health insurance or a benefit plan. Distribution or use of the Co-pay Card does not obligate use or continuing use of any specific product or provider. Patient or guardian is responsible for reporting the receipt of all Co-pay Card program benefits or reimbursement received, to any insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the Co-pay Card program, as may be required.

The Co-pay Card is not valid for medications the patient receives for free or that are eligible to be reimbursed by private insurance plans or other healthcare or pharmaceutical assistance programs (such as: GATCF or any other charitable organization) that reimburse the patient in part or for the entire cost of his/her medication.Patient, guardian, pharmacist, prescriber and any other person using the Co-pay Card agree not to seek reimbursement for all or any part of the benefit received by the recipient through the offer.

The Co-pay Card will be accepted by participating pharmacies, physician offices or hospitals.To qualify for the benefits of this Co-pay Card program, the patient may be required to pay out-of-pocket expenses for each treatment. Once enrolled, this Co-Pay Card program will not honour requests with date of serviceor medication dispensing that precede program enrolment by more than 120 days. This Co-pay Card is only available with a valid prescription and cannot be combined with any other rebate/coupon, free trial, or similar offer for the specified prescription. Use of this Co-pay Card must be consistent with all relevant health insurance requirements and payer agreements. Participating patients, pharmacies, physician offices and hospitals are obligated to inform third-party payers about the use of the Co-pay Card as providedfor under the applicable insurance or as otherwise required by contract or law. The Co-pay Card may not be sold, purchased, traded or offered for sale, purchase or trade. The Co-pay Card is limited to 1 per person during this offering period and is not transferable. This program expires within 12 months from enrolment. This program is not valid where prohibited by law. For Massachusetts’ residents, the Co-pay Card is not valid for any prescription drug that has an AB rated generic equivalentas determined by the United States Food and Drug Administration. For Massachusetts’ residents, this program shall expire on or before July 1, 2017.

The patient or their guardian must be 18 years or older to receive Co-pay Card program assistance.This Co-pay Card program is: (1) Void if the card is reproduced; (2) Void where prohibited by law; (3) only valid in the United States and Puerto Rico; and (4) only valid for Genentech products. Healthcare providers may not advertise or otherwise use the program as a means of promoting their services or Genentech’s products to patients. Genentech, Inc. reserves the right to rescind, revoke, or amend the program without notice at any time.

Please note: If at any time you do not wish to receive any further e-mails, mailings, or other communications about the Genentech Lucentis Co-pay Card, please call (855)218-5307 from 9 AM-8PM ET, Monday to Friday, and speak with a live agent.Click here to see frequently asked questions about the LUCENTIS Co-Pay Card Program.